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Validation of central serous chorioretinopathy multimodal imaging-based classification system

A Correction to this article was published on 06 November 2021

This article has been updated

Abstract

Purpose

Validation of a recently described central serous chorioretinopathy (CSCR) classification system and assessment of levels of agreement among 10 retina physicians.

Methods

This was a cross-sectional (inter-reader agreement) study. Ten retina physicians (assigned a role of masked grader) were provided with a comprehensive dataset of 61 eyes of 34 patients of presumed CSCR. Relevant clinical details and multimodal imaging (fundus autofluorescence, fluorescein and indocyanine green angiography, optical coherence tomography) of both involved and fellow eye were electronically shared. Later, only the fellow eye images were resent to understand the influence of affected eye on the grading of the fellow eye. Multiple inter-grader agreement using Fleiss Kappa was performed to determine the level of agreement among the 10 graders. p value of ≤ 0.05 was considered statistically significant.

Results

Sixty-one eyes of 34 patients were evaluated. There was moderate agreement for major criteria with Fleiss Kappa value of 0.50 (p < 0.0001) with a single outlier observer. After excluding that observer, the Fleiss Kappa value increased to 0.57 (p < 0.0001) with statistically significant p values among all categories, i.e., simple CSC (\(\kappa\) = 0.575), complex CSC (\(\kappa\) = 0.621), and no CSC (\(\kappa\) = 0.452). Overall, moderate to substantial agreement was noted among the subtypes (primary, recurrent, and resolved). The influence of the affected eye on fellow eye grading was studied. The global Fleiss Kappa coefficient (\(\kappa\) = 0.642, p < 0.0001) showed substantial agreement when observers were aware of the affected eye grading. However, without prior available information on the affected eye, the inter-grader agreement was significantly lower (global \(\kappa\) = 0.255, p < 0.0001).

Conclusion

A fair-moderate inter-grader agreement among the masked graders suggests a need for further refinement of this novel classification system. Disease grading should include both eyes as lack of information on affected eye has a bearing on fellow eye grading and inter-grader agreement as shown by a significant difference in global \(\kappa\) values.

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Acknowledgements

CSCR International Group

Affiliations

1. Pauline Aymard, Ophtalmopole, Cochin Hospital, University of Paris, France

2. Talal Beydoun, Ophtalmopole, Cochin Hospital, University of Paris, France

3. Elodie Bousquet, Ophtalmopole, Cochin Hospital, University of Paris, France

4. Francine Behar-Cohen, Ophtalmopole, Cochin Hospital, University of Paris, France

5. Chadi Mehanna, Ophtalmopole, Cochin Hospital, University of Paris, France

6. Jay Chhablani, Department of Ophthalmology, University of Pittsburgh Eye and Ear Institute, Pittsburgh, PA. USA

7. Chui Ming Gemmy Cheung, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.

8. Alejandra Daruich, Ophtalmopole, Cochin Hospital, University of Paris, France

9. K. Bailey Freund, Vitreous Retina Macula Consultants Of New York, New York, New York; Department of Ophthalmology, NYU School of Medicine, New York, New York, USA

10. Alain Gaudric, Université De Paris, Hopital Lariboisière, 2 Rue Ambroise Paré, 75,010 Paris, France

11. Camiel J.F. Boon, Department of Ophthalmology, Leiden University Medical Center, the Netherlands; Department of Ophthalmology, Amsterdam University Medical Centers, the Netherlands

12. Andrew Lotery, Faculty of Medicine, University Of Southampton, England.

13. Marco Lupidi, Department of Biochemical and Surgical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy

14. Irmela Mantel, Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Foundation Asile des Aveugles, 15 Avenue de France, CP 5143, CH-1000, Lausanne, Switzerland.

15. Thibaud Mathis, Croix-Rousse University Hospital, Hospices Civils de Lyon, UMR-CNRS 5510 Matéis, Lyon 1 University, France

16. Alexandre Matet, Ophtalmopole, Cochin Hospital, University of Paris, France

17. Martine Mauget-Faÿsse, Clinical Investigative Platform, Rothschild Foundation, 75,019 Paris, France

18. Sarah Mrejen, Department of Ophthalmology, XV-XX Ophthalmology National Hospital Center, Paris, France. Centre d'Imagerie et de Laser, 11 rue Antoine Bourdelle, 75,015, Paris, France.

19. Giuseppe Querques, School of Medicine, Vita-Salute San Raffaele University, Via Olgettina, 58, 20,132 Milan, Italy; Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20,132 Milan, Italy

20. Jorge Ruiz-Medrano, Puerta De Hierro-Majadahonda University Hospital, Madrid, Spain

21. Jose-Maria Ruiz-Moreno, Puerta De Hierro-Majadahonda University Hospital, Madrid, Spain

22. Shiri Shulman, Assuta Medical Centers, Tel Aviv, Israël

23. Sumit Randhir Singh, Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, La Jolla, CA, USA

24. Sobha Sivaprasad, NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, 162 City Road, London, EC1V2PD, UK

25. Richard F. Spaide, Vitreous Retina Macula Consultants Of New York, New York, New York, USA

26. Elon.H.C van Dijk, Department of Ophthalmology, Leiden University Medical Center, the Netherlands

27. Suzanne Yzer, Rotterdam Eye Hospital, Rotterdam, The Netherlands.

28. Min Zhao, Ophtalmopole, Cochin Hospital, University of Paris, France

29. Sandrine Zweifel, Department of Ophthalmology, University Hospital Zurich, Frauenklinikstrasse 24, 8091 Zurich, Switzerland And University of Zurich, Zurich, Switzerland

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No funds, grants, or other support was received.

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Correspondence to Jay Chhablani.

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Ethics approval

Ethical approval was waived by the local Ethics Committee of University of Pittsburgh in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Informed consent was obtained from all individual participants included in the study.

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Informed consent was obtained from all individual participants included in the study.

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The original version of this article was revised. The individual collaborator names under the group name “CSCR International Group” are now added.

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Chhablani, J., Behar-Cohen, F. & Central Serous Chorioretinopathy International Group. Validation of central serous chorioretinopathy multimodal imaging-based classification system. Graefes Arch Clin Exp Ophthalmol (2021). https://doi.org/10.1007/s00417-021-05452-1

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Keywords

  • Central serous chorioretinopathy
  • Optical coherence tomography
  • Fluorescein angiography
  • Indocyanine green angiography
  • Multimodal imaging
  • Inter-rater agreement
  • Fleiss Kappa coefficient